Healthcare Provider Details

I. General information

NPI: 1851344527
Provider Name (Legal Business Name): DIVERSIFIED TREATMENT ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 FAIRFIELD ROAD
LEWISBURG PA
17837
US

IV. Provider business mailing address

148 FAIRFIELD ROAD
LEWISBURG PA
17837
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-9986
  • Fax: 570-524-9973
Mailing address:
  • Phone: 570-524-9986
  • Fax: 570-524-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number348770
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number301960
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number308000
License Number StatePA

VIII. Authorized Official

Name: MR. TIMOTHY J KELLEHER
Title or Position: ADMINISTRATOR
Credential: MA MED
Phone: 570-524-9986